Akram Al-Ibraheem1, Nader Hirmas2, Stefano Fanti3, Diana Paez4, Fawzi Abuhijla5, Dalia Al-Rimawi6, Ula Al-Rasheed7, Riad Abdeljalil8, Feras Hawari9, Kamal Alrabi10, Asem Mansour11. 1. Department of Nuclear Medicine, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan. akramalibrahim@gmail.com. 2. Nuclear Medicine Clinic, Essen University Hospital, Hufelandstrasse 55, 45147, Essen, Germany. 3. Department of Nuclear Medicine, Policlinico S. Orsola, Università di Bologna, Bologna, Italy. 4. Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria. 5. Department of Radiation Oncology, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman, Jordan. 6. Office of Scientific and Academic Research (OSAR), King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman, Jordan. 7. Department of Nuclear Medicine, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan. 8. Department of Surgery, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan. 9. Department of Medicine, Section of Pulmonary and Critical Care, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan. 10. Department of Internal Medicine, Hematology and Oncology, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan. 11. Department of Diagnostic Radiology, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan.
Abstract
BACKGROUND: Staging of non-small-cell lung cancer (NSCLC) is a multidisciplinary process involving imaging, endoscopic and surgical techniques. This study aims at investigating the diagnostic accuracy of 18F-FDG PET/CT, CT scan, and endobronchial ultrasound/transbronchial needle aspirate (EBUS/TBNA) in preoperative mediastinal lymph nodes (MLNs) staging of NSCLC. METHODS: We identified all patients who were diagnosed with NSCLC at the King Hussein Cancer Center in Amman, Jordan, between July 2011 and December 2017. We collected their relevant clinical, radiological, and histopathological findings. The per-patient analysis was performed on all patients (N = 101) and then on those with histopathological confirmation (N = 57), followed by a per-lymph-node-station basis overall, and then according to distinct N-stage categories. RESULTS: 18F-FDG PET/CT, in comparison to CT, had a better sensitivity (90.5% vs. 75%, p = 0.04) overall and in patients with histopathological confirmation (83.3% vs. 54.6%), and better specificity (60.5% vs. 43.6%, p = 0.01) overall and in patients with histopathological confirmation in MLN staging (60.6% vs. 38.2%). Negative predictive value of mediastinoscopy, EBUS/TBNA, and 18F-FDG PET/CT were (87.1%), (90.91%), and (83.33%) respectively. The overall accuracy was highest for mediastinoscopy (88.6%) and EBUS/TBNA (88.2%), followed by 18F-FDG PET/CT (70.2%). Dividing patients into N1 disease vs. those with N2/N3 disease yielded similar findings. Comparison between 18F-FDG PET/CT and EBUS/TBNA in patients with histopathological confirmation shows 28 correlated true positive and true negative findings with final N-staging. In four patients, 18F-FDG PET/CT detected metastatic MLNs that would have otherwise remained undiscovered by EBUS/TBNA alone. Lymph nodes with a maximal standardized uptake value (SUVmax) more than 3 were significantly more likely to be true-positive. CONCLUSION: Multimodality staging of the MLNs in NSCLC is essential to provide accurate staging and the appropriate treatment. 18F-FDG PET/CT has better overall diagnostic utility when compared to the CT scan. The NPV of 18F-FDG PET/CT in MLNs is reliable and comparable to the NPV of EBUS/TBNA. SUVmax of MLNs can help in predicting metastases, but nevertheless, a positive 18F-FDG PET/CT MLNs particularly if such a result would change the treatment plan, should be verified histopathologically.
BACKGROUND: Staging of non-small-cell lung cancer (NSCLC) is a multidisciplinary process involving imaging, endoscopic and surgical techniques. This study aims at investigating the diagnostic accuracy of 18F-FDG PET/CT, CT scan, and endobronchial ultrasound/transbronchial needle aspirate (EBUS/TBNA) in preoperative mediastinal lymph nodes (MLNs) staging of NSCLC. METHODS: We identified all patients who were diagnosed with NSCLC at the King Hussein Cancer Center in Amman, Jordan, between July 2011 and December 2017. We collected their relevant clinical, radiological, and histopathological findings. The per-patient analysis was performed on all patients (N = 101) and then on those with histopathological confirmation (N = 57), followed by a per-lymph-node-station basis overall, and then according to distinct N-stage categories. RESULTS: 18F-FDG PET/CT, in comparison to CT, had a better sensitivity (90.5% vs. 75%, p = 0.04) overall and in patients with histopathological confirmation (83.3% vs. 54.6%), and better specificity (60.5% vs. 43.6%, p = 0.01) overall and in patients with histopathological confirmation in MLN staging (60.6% vs. 38.2%). Negative predictive value of mediastinoscopy, EBUS/TBNA, and 18F-FDG PET/CT were (87.1%), (90.91%), and (83.33%) respectively. The overall accuracy was highest for mediastinoscopy (88.6%) and EBUS/TBNA (88.2%), followed by 18F-FDG PET/CT (70.2%). Dividing patients into N1 disease vs. those with N2/N3 disease yielded similar findings. Comparison between 18F-FDG PET/CT and EBUS/TBNA in patients with histopathological confirmation shows 28 correlated true positive and true negative findings with final N-staging. In four patients, 18F-FDG PET/CT detected metastatic MLNs that would have otherwise remained undiscovered by EBUS/TBNA alone. Lymph nodes with a maximal standardized uptake value (SUVmax) more than 3 were significantly more likely to be true-positive. CONCLUSION: Multimodality staging of the MLNs in NSCLC is essential to provide accurate staging and the appropriate treatment. 18F-FDG PET/CT has better overall diagnostic utility when compared to the CT scan. The NPV of 18F-FDG PET/CT in MLNs is reliable and comparable to the NPV of EBUS/TBNA. SUVmax of MLNs can help in predicting metastases, but nevertheless, a positive 18F-FDG PET/CT MLNs particularly if such a result would change the treatment plan, should be verified histopathologically.
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Authors: Kajsa Ericson Lindquist; Inga Gudinaviciene; Nektaria Mylona; Rodrigo Urdar; Maria Lianou; Eva Darai-Ramqvist; Felix Haglund; Mátyás Béndek; Erika Bardoczi; Katalin Dobra; Hans Brunnström Journal: Biomolecules Date: 2021-11-18